Key Factors to Obtaining Reimbursement for Digital Therapeutics in the U.S.

While wellness apps have been successful in a direct-to-consumer model, many digital therapeutics (DTx) providers are working to obtain reimbursement from U.S. payers. In a heterogenous payer ecosystem, the key question is how to obtain broad payer coverage and reimbursement with a low out-of-pocket cost to the patient. Early prescription DTx companies have explored a range of options and had success negotiating payer payment through programmatic spend. However, in the past year, as U.S. payers are increasingly aware of prescription DTx, more would like to manage these products through direct, claims-based reimbursement.

Industry leaders Ed Cox, Molly Hoult, Everett Crosland, and Michael Rothrock participated in an insightful panel discussion on the key factors related to obtaining reimbursement for prescription DTx in the U.S. market:

Watch now to learn more about:

  • Current DTx payment options in the U.S.
  • How regulatory pathways impact payment options (regulated vs. unregulated; software-only [SaMD] products vs. products with hardware)
  • Coverage, reimbursement and coding requirements for claims-based reimbursement
  • Shift in U.S. payer perceptions of DTx over the past year and outlook for the future: MCIT, advent of digital formularies, etc.
  • How payers evaluate DTx coverage and think about setting reimbursement levels

Schedule a meeting with one of our Digital Medicine experts to learn more about how EVERSANA can help solve your Digital Medicine business challenges.

Author
Edward Cox
Executive Vice President, Strategic Alliances & Global Head of Digital Medicine

Widely recognized as a preeminent thought leader in digital therapeutics, Ed joins EVERSANA from Dthera Sciences, where as its CEO, he earned the FDA’s Breakthrough Device designation for a digital therapeutic to treat the…

Molly Hoult
Senior Principal

Molly Hoult is an expert at helping life science companies build value by meeting market needs better than their competitors. She digs deep into market and competitive dynamics to determine how best to develop…